“Health care” today focuses primarily on the treatment of illness and injury. Physicians, surgeons, nurses, and therapists work in an organized, highly-regulated system that responds to illness and injury after their occurrence. The care provided in this system begins with an allopathic diagnosis that is followed by treatment protocols heavily reliant on pharmaceuticals, surgical procedures and complex medical equipment. This system is primarily institution-based, and is subsidized by a third-party network of health insurance companies and government programs. Care giving venues are separately administered, with patients passing from one venue to the next along a treatment continuum depending on their level of acuity.
Since the health care system is not set up to foster wellness, but rather to respond to acute illness and injury, it is perhaps less a “health care” system than it is a “sickness-care” system. And the bulk of its patients—chronically ill, physically-disabled or frail-elderly people—receive ongoing acute-care services for exacerbations and complications of illnesses and conditions that cannot be cured. This system of reactive care does not offer concomitant adequate prevention services that educate and empower people to remain well, despite the growing emphasis on reducing unplanned hospitalizations and emergency room visits among those most vulnerable to severe illness and injury. For the most part, long-term care consumers interested in staying out of the hospital are left to their own devices, with or without the help of their families. The system through which consumers access community-based, long-term care supports is a difficult-to-negotiate patchwork of social service and disability-care services with multiple points of entry. Access professionals, including aging services social workers, health system case managers and social workers, and legal advocates differ in their knowledge base and assessment protocols.
Therefore, the health care system of the United States of America invariably confronts chronically ill, physically or cognitively disabled, or frail elderly health care receivers with significant inadequacies of the processes of care management, planning and funding. First, many parts of the social service and health care systems are inconsistent and disconnected. Indeed, the only point of convergence and continuity in the current system is the client and his or her family themselves. Patients and clients are passed from venue to venue, and from system to system, and are often subjected to redundant assessments and evaluations, with little information passing from one health care “silo” to another health care “silo” of each such venue. Second, the information clients are given from one venue to the next, and one worker to the next, is often incomplete, inaccurate, or both. This results from inconsistent knowledge and training for discharge planners, case managers or social workers serving clients across the continuum as to the nature and access rules for long-term prevention care programs.
Third, there are no consistent, standardized assessment protocols and no standardized teaching protocols as to the long-term care supports available in community settings. Fourth, because of short-term-stay models that dominate in-patient health care, and because of short-term and intermittent care models in rehabilitation and home health care services, and because of large caseloads carried by social workers in community-based aging and disability services, clients in need of long-term care support services and their families do not receive the kind of in depth planning, teaching and advocacy services they need. Moreover, as is the case for most people, such care receivers cannot afford to buy long-term care insurance, or are ineligible for coverage to begin with, or they cannot afford to pay for the care they need for as long as they need such long-term care. Fifth, and perhaps most importantly, there is no resource-planning component that assists long-term care consumers to develop care-funding plans that will enable them to actually organize their own resources and/or acquire the resources they need to pay for the prevention-focused, long-term, community-based care that supports and promotes the reduction of unplanned hospitalization and emergency room visits among those most vulnerable to requiring unplanned in-patient care.
Accordingly, there is a need for a solution to the problems created by the present non-standardized process of long-term care funding and care planning.